New Age Kidney Donation: The Laparoscopic Way

I discovered the TransWeb site after deciding to donate a kidney to my brother. My decision had been made, pre-donation testing was complete, it was just a matter of waiting and I was nervous and eager to know more about what lay ahead. Maybe you are in a similar boat, but whatever reason brought you here, I think you will find that this site provides valuable information about the kidney donation experience.

Over two evenings, I read every one of the donor stories and I strongly encourage you to do the same. Each one has a unique perspective and emphasizes different aspects of the donation process that may turn out to be particularly relevant to you.

So, why another story? There are two reasons. First, things have changed substantially for the donor since about 1996 (the earliest donor stories on TransWeb). Donor kidney "harvest" (there's the ultimate euphemism for you!) is now frequently done using a laparoscopic procedure. The resulting incisions are smaller, there is no need for rib cutting, and recovery time is shorter as compared to the older "open surgery" method described by the other donors. Since this procedure is becoming more common, TransWeb visitors should know more about it. Note: When I wrote this story, I had not seen "But for the Grace of God..." by Karen. Hers is the first TransWeb story about the laparoscopic procedure. If you haven't already, be sure to read it. In addition to gaining a woman's perspective on kidney donation, you'll learn how she used the power of prayer to make the difficult decision to be the first laparoscopic donor in her part of the United States.

There's another thing too, at least for me there was - the "Fear Factor". Without exception, the other donors on TransWeb describe their eagerness to donate. Michelle, in "Donating a Kidney: A Love Story" wonders how she and her sister would have resolved the problem of who got the honor of donating if they both were good matches for their mom. I didn't have quite this Gung-Ho attitude. I knew my brother needed a kidney and I knew I was the only appropriate donor but I worried some. If you're interested, I don't mind telling you what I worried about and how I dealt with it. (see "Fear Factor" section)

Preliminaries

The transplant process kicked off in early December, 2002 when my brother's kidney failed and he began a thrice weekly dialysis regimen. I say kidney, because he was operating on one cylinder, a single kidney he had received from my younger sister nearly 20 years earlier. He has had type I (juvenile onset) diabetes since age 9 and had lost his own kidney function at age 33. At that time I had two young daughters and a third on the way. I felt I needed to save my "extra" kidney for possible donation to one of them since juvenile diabetes is known to run in families.

My youngest is now 19 and all three are healthy. It was my turn! We signed on to a mid-February 2003 date for the kidney swap at New York Presbyterian Hospital in New York City, our home town and my brother's current residence. I was almost 54, he 52.

Prior to transplant, both donor and recipient go through extensive medical screening to determine their immunologic compatibility and to verify that they are healthy enough to undergo the surgery. In our case this took almost two and a half months. It seemed to both of us that it could have been done much more quickly. I made four trips from my home in Eastern Connecticut to Manhattan for various tests which included medical history, blood work, a physical exam, 24 hour urine collection, chest x-ray, cardiac stress test, renal scan, three-dimensional CT scan of my kidneys and a face to face meeting with the surgeon. These tests are all quite standard and are described in most of the other stories. There has, however, been one important improvement in the renal scan (also called a renal angiogram). My renal scan was much less invasive than those described by the other donors (e. g. Michelle in "Donating a Kidney: A Love Story). There was no need for sedation, and the dye was injected into an iv line in my hand. No incision in the groin was required. The procedure was over and I was on my way in less than an hour with absolutely no after effects of any kind.

The Laparoscopic Procedure

The laparoscopic nephrectomy procedure (LP from here on) was developed at Washington University in 1990, and was first used for living kidney donation in 1995, at Johns Hopkins. It is now in use throughout the U.S. and, in fact, much of the developed world. However, I don't have any information on the relative percentages of donations done using LP versus the "open surgery" method.

Unlike open surgery, which requires a 6-10 inch incision and sometimes partial removal of a rib, LP involves three one-half inch incisions which serve as entry points: one for the laparoscope (a TVcamera on a thin cable) and two for the surgical instruments. Additionally, a 2-3 inch incision several inches below the belly button provides the opening through which the kidney is removed.

In my case, a fifth incision about one and one-half inches long was required in order to provide entry for an additional instrument that was used to hold the kidney in place while it was being dissected from me (uuuggggh!). My surgeon explained that this is common in cases where the donor is a big person with big kidneys (I'm 6'4" and went into the operating room weighing about 225 lbs). LP also entails pumping carbon dioxide into the abdominal cavity to create some room for manipulation of the surgical instruments.

After all the ballyhoo from my transplant coordinator about the advantages of LP, I was taken by surprise when asked to give permission for use of the open procedure if any complication with LP arose. My surgeon explained that in approximately 700 LP's, he had had to resort to the "open surgery" procedure in only two cases.

The Blow By Blow Account!

(You may find it interesting to compare this with the chronology provided towards the end of the "The Steve G Story".)

Wednesday (day before surgery)

No solid food, just clear liquids. Traveled to New York City and checked into a hotel room on the hospital grounds. Took a laxative at 2:00 pm, stayed close to the toilet bowl and tried to think happy thoughts. My brother arrived around 10:30 after his last dialysis treatment. We talked a little then went to bed about 11:30 p.m. and slept fairly well.

Thursday (surgery day)

Arrived at hospital 5:45 a.m. Checked in, got into hospital garb (you know, that stupid gown that no matter what you do, your butt sticks out) had a brief visit with a nurse and nervously paced (almost jogged in place) in a waiting area for one-half hour until called to the operating room. Kidney donors at New York Presbyterian actually walk into the operating room where a nurse verifies your identity and your reason for being there. Then you lie down in a crucifixion pose on the operating table and the anesthesiologist begins wiring you up for meds. I was very apprehensive but remember trading a few corny jokes with the doctor and nurses. That was 7:30 a.m.

Consciousness returned at 1:00 p.m. after I had been in the recovery room for 2 hours. The surgery was over, had been successful and my brother was producing urine with his new kidney. I dozed in the recovery room till 5-6ish at which time I was taken to my room. I was able to get from the gurney into my bed by myself. About 6 p.m. I received my first post-operative pain medication (Toradol) via my IV fluid line. That stuff is great. It's non-sedating, non-constipating and I had no pain worth mentioning at any time.

Until the next morning I was only allowed a few ice chips for thirst, no food of any kind. I was a little thirsty, but the ice chips sufficed. I was not the least bit hungry. I watched a little TV but conked out pretty early and slept fairly well.

Friday (day 1 post-op)

Got up out of bed about 5 a.m. because I was tired of lying down and knew I was supposed to walk as much as possible. Nurses were surprised to see me wandering around at that hour and chased me back to bed.

At 7 a.m. my nurse removed the Foley catheter. Just as Steve G wrote - no big deal. But it was good for my morale to have one less tube coming out of me. Particularly that one!

My surgeon came by about 9 a.m., assured me that all had gone well and that I would be discharged the next morning.

I spent the day wandering the halls, visiting with my brother, having visits from my wife, sister, and daughter and her boyfriend, and catching little naps. About 2:30 p.m.the carbon dioxide gas had been absorbed into my intestines and I started to blow up like a balloon. I was very uncomfortable and a little scared to be honest. A suppository took care of that in about an hour. The evening dragged on. I didn't fall asleep till well after midnight.

Saturday (day 2 post-op)

5 a.m. received my last dose of pain medication. Breakfast came at 7 a.m. Still had no appetite; had only juice and jello. Slowly got washed up and dressed, visited with my brother and at 10 a.m. (about 50 hours after my admission to the hospital), was on my way home with my wife.

Sunday - Thursday at home (days 3 - 7)

Laid around like a bum and let my poor wife cater to me. Annoyed my two college student daughters via Instant Messaging. Did a lot of reading and a fair amount of napping. Appetite was very slow in returning. Lived on homemade chicken barley soup and poached eggs with toast for most of the week. Wednesday evening took a 12-minute turn on the exercise bike. Thursday got outside and shoveled snow for 45 minutes, the cold air felt good and so did the exercise.

Friday (day 8)

Went to the gym for the first time. Ran 1.5 miles slowly on the treadmill then did about 20 minutes of very easy weight lifting (had the doc's ok to try this). Felt good, but tired. Still eating very lightly and found bowel movements a little painful.

Sunday (day 10)

Back to gym for a second workout, still tired but felt benefit from the exercise.

Monday (day 11)

Drove 30 miles to work (in violation of nurse's orders not to drive for 2 weeks) - had no problems. Also, had no problem with working a full day at my office job.

Rest of week (2nd week after surgery)

Worked every day, went to the gym every third day. Noticed a milky discharge from one of my incisions. Emailed my surgeon about it, he told me not to worry, that it was lymph. Produced quite a bit of this fluid over 48 hours until it stopped as mysteriously as it had begun. Never got a detailed explanation from him. A veterinarian friend concluded that a lymph node had been cut during the operation and this was aggravated by the exercise. I decided against allowing him to conduct exploratory surgery to verify his theory!

Final recovery issues

Had a major 48-hour bout of constipation just over two weeks post-surgery, needed a laxative. Surgeon said this was not uncommon and attributed it to anesthesia! I won't laugh at those old folks on the "Milk of Magnesia" commercials any more!

Had a period of belly swelling just after the lymph incident which lasted about 5 days and then spontaneously went away at three weeks post-operation. Surgeon couldn't explain this one and would have ordered a CT scan if it had persisted much longer. Chose to take the week off from running and weightlifting due to the swelling. Have now resumed full physical activities.

There you have it, every last boring detail! Though about 18 pounds lighter, (beer belly has mysteriously vanished!) I consider myself fully recovered at just over 4 weeks post-operation.

The Fear Factor

As I said at the beginning, once I decided to donate, my mind was made up. However, that is not to say that I didn't find myself worrying from time to time. You see, prior to the donation, I had never been admitted to a hospital for any reason. Now, I'm not the kind of person who's "scared of needles" but let me assure you, the idea of being unconscious and having some strangers (no matter how well qualified) removing organs did not appeal to me.

I had three concerns.

  1. Through some fluke, the surgery itself could cost me my life.
  2. The operation could be botched in some way and I would find myself not as good as new.
  3. The surgery might go fine but unrelated kidney problems could arise later in my life.

As I thought about my concerns I began to realize that my fears were based largely on a reluctance to accept my mortality. Surprising, you may think, that a person in his 50's could be so deluded!

The more time I spent in the New York Presbyterian Hospital waiting rooms during my pre-operation testing visits, the more I saw of the suffering of my brother and many other folks in a similar plight. I started feeling ashamed and selfish for even worrying about myself. During the train ride home one day I remembered a quote attributed to Mike Tyson of all people. I know, he's not the average person's idea of a role model! He was asked if he was frightened before his fights. He said that he always was and that the trick was to turn the fear to advantage. By this he meant that he forced himself to train harder and to be hyperaware and focused in the ring. I decided this was good strategy and began to implement it in my own way.

I upped my cardiovascular exercise level and began to learn all I could about kidneys and the surgery ahead. I started running several miles 3-4 times a week in addition to continuing a fairly serious weight lifting program which I had been following for 18 months. Steve G talks about the value of exercise as preparation for kidney donation. He emphasizes the health benefits; I found it an excellent distraction as well.

I questioned my transplant coordinator and surgeon at length about the gory details of the operation, how many he had done, what kind of complications he had encountered, what recovery was like… The answers were reassuring.

I began an email correspondence with Steve Glazewski after reading his story. He was most friendly and encouraging. I think he did more to put my mind at ease than anyone.

Still I worried some.

Further comfort came, from of all people, Ebenezer Scrooge. I am, you see, a huge fan of Charles Dickens. In fact, I try and read the "Christmas Carol" every December. I don't always get around to it, but whenever I do, I always get something new out of it. ("Why doesn't this guy get a life?" you may be saying to yourself!)

Anyway, there is a scene where the Ghost of Christmas Yet to Come shows Scrooge his own deathbed. Scrooge observes the dismal scene and realizes his miserly ways have earned him nothing. It dawns on him that in devoting himself to his own self interest he has lived a meaningless and empty life.

I thought of my own situation. The peace of mind of knowing that I could choose to die with two functioning kidneys and perhaps without ever being really sick a day in my life suddenly seemed rather insignificant. Was there any real value in having two functioning kidneys while my brother had none? Hadn't my little sister undergone the more radical open surgery procedure 20 years ago and continue to live a normal life afterwards, as have thousands of others? Being in perfect health, was I really such a chicken that I couldn't risk surgery in a modern hospital under the care of a surgeon who had successfully performed the procedure 700 some times?

The answers were clear.

Ed Kadyszewski